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Abstract: Applied behavior analytic approaches to problem behavior are generally focused on identifying the function of problem behavior, and then using that information to inform treatment design. It is also widely recognized that caregiver behaviors that reinforce child problem behavior are governed by reinforcement contingencies, namely negative reinforcement. Though there is an awareness of the bi-directional nature of caregiver-child interactions, this topic has received limited attention, and an explicit technology for systematically addressing these issues is lacking. The first presentation will review known caregiver-child interactions that perpetuate maladaptive patterns of interaction, discuss the collateral emotional responses these may induce among caregivers that interfere with adherence with recommendations, and review findings on the use of Mindfulness and Acceptance and Commitment Therapy (ACT) for helping residential staff who work with individuals with problem behavior. The second presentation will describe how this approach can be used to address the collateral emotional behaviors of parents associated with escape and avoidance of child problem behavior, and present outcomes obtained using a single-case experimental design to evaluate an ACT-informed strategy. The discussant will synthesize information summarized by the presenters and comment more broadly on the potential use of ACT-informed approaches to alter maladaptive caregiver-child interactions.

Instruction Level: Advanced

Keyword(s): ACT, Caregiver training, Mindfulness, Problem behavior

Translating and Applying Mindfulness/Acceptance and Commitment Therapy for Caregivers of Individuals With Problem Behavior

Abstract: Due to the complex functional relationships that exist between children and caregivers when behavioral treatment plans for problem behavior are implemented, a systematic analysis of the contingencies related to treatment adherence is warranted (Allen & Warzak, 2000; Stocco &Thompson, 2015). Child problem behavior may occasion caregiver responses maintained by cessation of problem behavior and relief from aversive emotional experiences. Previous research investigating painful medical procedures and child anxiety has indicated emotional responding by caregivers due to observation of child distress can affect caregiver behavior and treatment adherence. This has direct relevance to problem behavior, where collateral emotional behavior is often not addressed in a conceptually systematic way. Using a behavior analytic framework, we review the literature to evaluate how applying mindfulness and acceptance and commitment therapy (ACT) strategies for caregivers of individuals with developmental disabilities who displayed severe problem behavior, affected caregiver emotional experiences (e.g., stress levels) and behavioral intervention implementation. A critical evaluation of the effectiveness of the application of the strategies to date, how well the programs evaluated align with the core principles of ACT and mindfulness, and potential reasons why these strategies can be of use for researchers and clinicians will be discussed.

Abstract: Research suggests that attempting to suppress, or distract oneself from, an aversive experience (e.g. unpleasant private event such as a thought or emotion) produces a paradoxical effect of strengthening the experience (Wegner et al., 1987); this phenomenon may be relevant for caregivers who implement extinction for child problem behavior. If child problem behavior occasions an aversive emotional experience and emotional responding from a caregiver, an attempt to ignore or distract oneself may potentiate the aversiveness and increase the likelihood that the caregiver may attend to the behavior to produce its cessation. In the current study, we used a multiple-probe design across participants to investigate the effectiveness of an Acceptance and Commitment Therapy (ACT) procedure to assist the parents in implementing attention-extinction. The procedure focused on sensitizing the parents to (rather than distracting from) the aversive experience of observing problem behavior while withholding attention. Results indicated that, for both parents, the ACT-informed procedure produced clinically significant improvements compared to baseline, led to sustained behavior changes, and was considered socially acceptable. In addition to reporting outcomes, this paper will describe in behavior analytic terms the ACT strategy and it’s similarity to concepts discussed by Ferster (1973), Goldiamond (1974), and Skinner (1969).